Family Resiliency in Childhood Cancer

Based on in-depth interviews with 42 parents (25 mothers, 17 fathers) in 26 families who had had a child treated for cancer within the previous 3 years, resiliency factors that helped the family recover were identified. The resiliency factors included internal family rapid mobilization and reorganization; social support from the health care team, extended family, the community, and the workplace; and changes in appraisal to make the situation more comprehensible, manageable, and meaningful.

Key Words: cancer, childhood, illness, resiliency, social support.

Childhood cancer represents a life-threatening situation for the child and a severe trauma for the family. When a child is diagnosed with cancer, the family system is faced with many new stressors and demands (e.g., repeated hospitalizations with extensive and often painful treatments for the child, alterations in the parent-child relationship and sibling care, parental occupational and role changes, and concerns about the long-term effects on both the child and family). Uppermost in the minds of parents and other family members is the question of whether the child will survive this serious illness.

Childhood cancer is indeed the second leading cause of mortality in children (Ward, 2000). However, childhood cancer survival rates now approach 70 to 80% for some types of leukemia, and rates above 90% for Hodgkins' disease, retinoblastoma, and germ cell tumors have been reported (Eiser, 1998). Improved survival rates in childhood cancer have been brought about by more potentially toxic and intensive treatment regimens, and the long-term physical, psychosocial, and familial effects on this population of children and families is still being determined.

Recent advances in pediatric cancer survival have led to a need for a shift in the research away from an emphasis on coping with a disease that was invariably fatal to gaining a better understanding of how the child, parents, and family unit adapt and recover both during the active treatment phase and in long-term survival. Identifying the modifiable family psychosocial risk and resistance factors associated with treatment can help target those who are at particular risk and identify and implement sound proactive intervention strategies.

One research emphasis of childhood cancer in the family has focused on the prevalence of posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) in the parents. Reports of current PTSD in mothers of survivors has ranged from 6.2% (Manne, DuHamel, Gallelli, Sorgen, & Redd, 1998) to 54% for lifetime PTSD in mothers of survivors, with interview data supporting the assumption that this higher level of stress was from the childhood cancer experience (Pelcovitz et al., 1996). Symptoms reflecting a severe level of posttraumatic stress were found in 39.7% of mothers by Stuber, Christalkis, Housekamp, and Kazak (1996). These traumatic stress symptoms in mothers are related to long-term adjustment difficulties (Barakat, Kazak, Gallagher, Meeske, & Stuber, 2000). Fewer studies have examined PTSD/PTSS in fathers, but rates of 7.1% and 28.3% for severe and moderate PTSD symptoms respectively (Barakat et al., 1997) and overall PTSS rates of 33.3% in fathers (Stuber et al.) are reported. Clearly both parents are affected by their child's cancer, and parents of childhood cancer survivors have higher rates of PTSD/PTSS than parents of healthy children (Barakat et al., 1997; Pelcovitz et al.). Although these findings can be viewed as alarming, they also indicate that well over half-and in some samples more than three fourths-of parents do not show evidence of PTSD or PTSS.

Earlier work has indicated that family cohesion is strengthened by childhood cancer, with spouses being an important source of support for each other; however, over time as the child's hospitalizations increase, marital quality and spousal support declines (Barbarin, Hughes, & Chesler, 1985). …

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